Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 108 Kindle Road, Randle, Washington |
Authorized Official Name and Position | Richard Boggess (CFO) |
Authorized Official Contact | 3604965112 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1138 Morton WA 98356-0019 Ph: (360) 496-5112 | 108 Kindle Road Randle WA 98377 Ph: (360) 497-3333 |
NPI Number | 1689604563 |
---|---|
Provider Enumeration Date | 07/04/2006 |
Last Update Date | 08/20/2019 |
Medicare PECOS PAC ID | 6002727385 |
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Medicare Enrollment ID | O20030911000009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1689604563 | NPI | - | NPPES |
7111230 | Medicaid | WA | |
DB0062 | Other | WA | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | H173 (Washington) | Primary |